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H: the surprising truth about heroin and addiction.


In 1992 The New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
 Times carried a frontpage story about a successful businessman who happened to be a regular heroin user. It began: "He is an executive in a company in New York, lives in a condo on the Upper East Side of Manhattan, drives an expensive car, plays tennis in the Hamp tons and vacations with his wife in Europe and the Caribbean. But unknown to office colleagues, friends, and most of his family, the man is also a longtime heroin user. He says he finds heroin relaxing and pleasurable and has seen no reason to stop using it until the woman he recently married insisted that he do so. 'The drug is an enhancement of my life; he said. 'I see it as similar to a guy coming home and having a drink of alcohol. Only alcohol has never done it for me.'"

The Times noted that "nearly everything about the 44-year-old executive...seems to fly in the face of to defy; to brave; to withstand.
to insult; to assail; to set at defiance; to oppose with violence; to act in direct opposition to; to resist.

See also: Face Fly
 widely held perceptions about heroin users." The reporter who wrote the story and his editors seemed uncomfortable with contradicting official anti-drug propaganda, which depicts heroin use as incompatible with a satisfying, productive life. The headline read, "Executive's Secret Struggle With Heroin's Powerful Grip;' which sounds more like a cautionary tale A cautionary tale is a traditional story told in folklore, to warn its hearer of a danger.

There are three essential parts to a cautionary tale, though they can be introduced in a large variety of ways.
 than a success story. And the Times hastened to add that heroin users "are flirting with disaster." It conceded that "heroin does not damage the organs as, for instance, heavy alcohol use does." But it cited the risk of arrest, overdose, AIDS, and hepatitis--without noting that all of these risks are created or exacerbated by prohibition.

The general thrust of the piece was: Here is a privileged man who is tempting fate by messing around with a very dangerous drug. He may have escaped disaster so far, but unless he quits quits  
adj.
On even terms with by payment or requital: I am finally quits with the loan.



[Middle English, probably alteration (influenced by Medieval Latin
 he will probably end up dead or in prison.

That is not the way the businessman saw his situation. He said he had decided to give up heroin only because his wife did not approve of the habit. "In my heart," he said, "I really don't feel there's anything wrong with using heroin. But there doesn't seem to be anyway in the world I can persuade my wife to grant me this space in our relationship. I don't want to lose her, so I'm making this effort."

Judging from the "widely held perceptions about heroin users" mentioned by the Times, that effort was bound to fail. The conventional view of heroin, which powerfully shapes the popular understanding of addiction, is nicely summed up in the journalist Martin Booth's 1996 history of opium opium, substance derived by collecting and drying the milky juice in the unripe seed pods of the opium poppy, Papaver somniferum. Opium varies in color from yellow to dark brown and has a characteristic odor and a bitter taste. . "Addiction is the compulsive taking of drugs which have such a hold over the addict he or she cannot stop using them without suffering severe symptoms and even death;' he writes. "Opiate opiate /opi·ate/ (o´pe-it)
1. any drug derived from opium.

2. hypnotic (2).


o·pi·ate
n.
1.
 dependence...is as fundamental to an addict's existence as food and water, a physio-chemical fact: an addict's body is chemically reliant upon its drug for opiates Opiates
Analgesic, pain killing drugs, such as heroin and morphine that depress the central nervous system.

Mentioned in: Withdrawal Syndromes
 actually alter the body's chemistry so it cannot function properly without being periodically primed. A hunger for the drug forms when the quantity in the bloodstream falls below a certain level....Fail to feed the body and it deteriorates and may die from drug starvation." Booth also declares that "everyone...is a potential addict"; that "addiction can start with the very first d ose"; and that "with continued use addiction is a certainty."

Booth's description is wrong or grossly misleading in every particular. To understand why is to recognize the fallacies This is a list of fallacies. Formal fallacies
Formal fallacies are arguments that are fallacious due to an error in their form or technical structure.
  • Argument from fallacy
 underlying a reductionist re·duc·tion·ism  
n.
An attempt or tendency to explain a complex set of facts, entities, phenomena, or structures by another, simpler set: "For the last 400 years science has advanced by reductionism ...
, drug-centered view of addiction in which chemicals force themselves on people-a view that skeptics such as the maverick psychiatrist Thomas Szasz and the psychologist Stanton Peele have long questioned. The idea that a drug can compel the person who consumes it to continue consuming it is one of the most important beliefs underlying the war on drugs, because this power makes possible all the other evils to which drug use supposedly leads.

When Martin Booth tells us that anyone can be addicted to heroin, that it may take just one dose, and that it will certainly happen to you if you're foolish enough to repeat the experiment, he is drawing on a long tradition of anti-drug propaganda. As the sociologist Harry G. Levine has shown, the original model for such warnings was not heroin or opium but alcohol. "The idea that drugs are inherently addicting," Levine wrote in 1978, "was first systematically worked out for alcohol and then extended to other substances. Long before opium was popularly accepted as addicting, alcohol was so regarded." The dry crusaders 'of the 19th and early 20th centuries taught that every tippler tip·ple 1  
tr. & intr.v. tip·pled, tip·pling, tip·ples
To drink (alcoholic liquor) or engage in such drinking, especially habitually or to excess.

n.
Alcoholic liquor.
 was a potential drunkard One who habitually engages in the overindulgence of alcohol.

In order for an individual to be labeled a drunkard, drunkenness must be habitual or must recur on a constant basis.
, that a glass of beer was the first step on the road to ruin, and that repeated use of distilled spirits made addiction virtually inevitable. Today, when a kitchen wrecked by a skinny model wielding a frying pan is supposed to symbolize the havoc caused by a snort of heroin, similar assumptions about opiates are even more widely held, and they likewise are based more on faith than facts.

Withdrawal Penalty

Beginning early in the 20th century, Stanton Peele notes, heroin "came to be seen in American society as the nonpareil Nonpareil - One of five pedagogical languages based on Markov algorithms, used in ["Nonpareil, a Machine Level Machine Independent Language for the Study of Semantics", B. Higman, ULICS Intl Report No ICSI 170, U London (1968)]. The others were Brilliant, Diamond, Pearl and Ruby.  drug of addiction-as leading inescapably from even the most casual contact to an intractable dependence, withdrawal from which was traumatic and unthinkable for the addict." According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 this view, reflected in Booth's gloss and other popular portrayals, the potentially fatal agony of withdrawal is the gun that heroin holds to the addict's head. These accounts greatly exaggerate both the severity and the importance of withdrawal symptoms Withdrawal symptoms
A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.
.

Heroin addicts who abruptly stop using the drug commonly report flu-like symptoms, which may include chills, sweating, runny nose runny nose Vox populi → medtalk Rhinorrhea  and eyes, muscular aches, stomach cramps, nausea, diarrhea, or headaches. While certainly unpleasant, the experience is not life threatening. Indeed, addicts who have developed tolerance (needing higher doses to achieve the same effect) often voluntarily undergo withdrawal so they can begin using heroin again at a lower dose, thereby reducing the cost of their habit. Another sign that fear of withdrawal symptoms is not the essence of addiction is the fact that heroin users commonly drift in and out of their habits, going through periods of abstinence and returning to the drug long after any physical discomfort has faded away. Indeed, the observation that detoxification Detoxification Definition

Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body.
 is not tantamount to overcoming an addiction, that addicts typically will try repeatedly before successfully kicking the habit, is a commonplace of drug treatment.

More evidence that withdrawal has been overemphasized as a motivation for using opiates comes from patients who take narcotic narcotic, any of a number of substances that have a depressant effect on the nervous system. The chief narcotic drugs are opium, its constituents morphine and codeine, and the morphine derivative heroin.

See also drug addiction and drug abuse.
 painkillers overextended overextended,
adj 1. the situation occurring when a prosthetic appliance is inadvertently constructed in such a way that part of the oral mucosa is injured by the appliance.
adj 2.
 periods of time. Like heroin addicts, they develop "physical dependence" and experience withdrawal symptoms when they stop taking the drugs. But studies conducted during the last two decades have consistently found that patients in pain who receive opioids Opioids
One of the major classes of semi or fully synthetic psycho-active drugs that includes methadone.

Mentioned in: Cancer Therapy, Palliative, Methadone

opioid 
 (opiates or synthetics with similar effects) rarely become addicted.

Pain experts emphasize that physical dependence should not be confused with addiction, which requires a psychological component: a persistent desire to use the substance for its mood-altering effects. Critics have long complained that unreasonable fears about narcotic addiction discourage adequate pain treatment. In 1989 Charles Schuster, then director of the National Institute on Drug Abuse The National Institute on Drug Abuse (NIDA) is a United States federal-government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction. , confessed, "We have been so effective in warning the medical establishment and the public in general about the inappropriate use of opiates that we have endowed en·dow  
tr.v. en·dowed, en·dow·ing, en·dows
1. To provide with property, income, or a source of income.

2.
a.
 these drugs with a mysterious power to enslave en·slave  
tr.v. en·slaved, en·slav·ing, en·slaves
To make into or as if into a slave.



en·slavement n.
 that is overrated Overrated was a Horde World of Warcraft guild, based on the US Black Dragonflight Realm. On November 2 2006, the majority of the guild members were indefinitely banned from the game for use of (or directly benefiting from) a third-party "wall-hack", used to bypass content ."

Although popular perceptions lag behind, the point made by pain specialists--that "physical dependence" is not the same as addiction--is now widely accepted by professionals who deal with drug problems. But under the heroin-based model that prevailed until the 1970s, tolerance and withdrawal symptoms were considered the hallmarks of addiction. By this standard, drugs such as nicotine and cocaine were not truly addictive; they were merely "habituating." That distinction proved untenable, given the difficulty that people often had in giving up substances that were not considered addictive.

Having hijacked the term addiction, which in its original sense referred to any strong habit, psychiatrists ultimately abandoned it in favor of substance dependence. "The essential feature of Substance Dependence," according to the American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. , "is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems....Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence." Instead, the condition is defined as "a maladaptive Maladaptive
Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.

Mentioned in: Cognitive-Behavioral Therapy
 pattern of substance use" involving at least three of seven features. In addition to tolerance and withdrawal, these include using more of the drug than intended; trying unsuccessfully to cut back; spending a lot of time getting the drug, using it, or recovering from its effects; giving up or reducing important social, occupational, or recreational activities because of drug use; and continuing use even while recognizing drug-related psychological or physical problems.

One can quibble QUIBBLE. A slight difficulty raised without necessity or propriety; a cavil.
     2. No justly eminent member of the bar will resort to a quibble in his argument.
 with these criteria, especially since they are meant to be applied not by the drug user himself but by a government-licensed expert with whose judgment he may disagree. The possibility of such a conflict is all the more troubling because the evaluation may be involuntary (the result of an arrest, for example) and may have implications for the drug user's freedom. More fundamentally, classifying substance dependence as a "mental disorder mental disorder

Any illness with a psychological origin, manifested either in symptoms of emotional distress or in abnormal behaviour. Most mental disorders can be broadly classified as either psychoses or neuroses (see neurosis; psychosis). Psychoses (e.g.
" to be treated by medical doctors suggests that drug abuse is a disease, something that happens to people rather than something that people do. Yet it is clear from the description that we are talking about a pattern of behavior. Addiction is not simply a matter of introducing a chemical into someone's body, even if it is done often enough to create tolerance and withdrawal symptoms. Conversely, someone who takes a steady dose of a drug and who can stop using it without physical distress may still be addicted to it.

Simply Irresistible?

Even if addiction is not a physical compulsion, perhaps some drug experiences are so alluring that people find it impossible to resist them. Certainly that is heroin's reputation, encapsulated in the title of a 1972 book: It's So Good, Don't Even Try It Once.

The fact that heroin use is so rare-involving, according to the government's data, something like 0.2 percent of the U.S. population in 2001--suggests that its appeal is much more limited than we've been led to believe. If heroin really is "so good," why does it have such a tiny share of the illegal drug market? Marijuana is more than 45 times as popular. The National Household Survey on Drug Abuse indicates that about 3 million Americans have used heroin in their lifetimes; of them, 15 percent had used it in the last year, 4 percent in the last month. These numbers suggest that the vast majority of heroin users either never become addicted or, if they do, manage to give the drug up. A survey of high school seniors found that 1 percent had used heroin in the previous year, while 0.1 percent had used it on 20 or more days in the previous month. Assuming that daily use is a reasonable proxy for opiate addiction, one in 10 of the students who had taken heroin in the last year might have qualified as addicts. The se are not the sort of numbers you'd expect for a drug that's irresistible.

True, these surveys exclude certain groups in which heroin use is more common and in which a larger percentage of users probably could be described as addicts. The household survey misses people living on the street, in prisons, and in residential drug treatment programs, while the high school survey leaves out truants and dropouts. But even for the entire population of heroin users, the estimated addiction rates do not come close to matching heroin's reputation. A 1976 study by the drug researchers Leon G. Hunt and Carl D. Chambers estimated there were 3 or 4 million heroin users in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , perhaps 10 percent of them addicts. "Of all active heroin users," Hunt and Chambers wrote, "a large majority are not addicts: they are not physically or socially dysfunctional; they are not daily users and they do not seem to require treatment." A 1994 study based on data from the National Comorbidity Survey estimated that 23 percent of heroin users ever experience substance dependence.

The comparable rate for alcohol in that study was 15 percent, which seems to support the idea that heroin is more addictive: A larger percentage of the people who try it become heavy users, even though it's harder to get. At the same time, the fact that using heroin is illegal, expensive, risky, inconvenient, and almost universally condemned means that the people who nevertheless choose to do it repeatedly will tend to differ from people who choose to drink. They will be especially attracted to heroin's effects, the associated lifestyle, or both. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently
, heroin users are a self-selected group, less representative of the general population than alcohol users are, and they may be more inclined from the outset to form strong attachments to the drug.

The same study found that 32 percent of tobacco users had experienced substance dependence. Figures like that one are the basis for the claim that nicotine is "more addictive than heroin." After all, cigarette smokers typically go through a pack or so a day, so they're under the influence of nicotine every waking moment. Heroin users typically do not use their drug even once a day. Smokers offended by this comparison are quick to point out that they function fine, meeting their responsibilities at work and homey despite their habit. This, they assume, is impossible for heroin users. Examples like the businessman described by The New York Times indicate otherwise.

Still, it's true that nicotine's psychoactive psychoactive /psy·cho·ac·tive/ (-ak´tiv) psychotropic.

psy·cho·ac·tive
adj.
Affecting the mind or mental processes. Used of a drug.
 effects are easier to reconcile with the requirements of everyday life than heroin's are. Indeed, nicotine can enhance concentration and improve performance on certain tasks. So one important reason why most cigarette smokers consume their drug throughout the day is that they can do so without running into trouble. And because they're used to smoking in so many different settings, they may find nicotine harder to give up than a drug they use only with certain people in secret. In one survey, 57 percent of drug users entering a Canadian treatment program said giving up their problem substance (not necessarily heroin) would be easier than giving up cigarettes. In another survey, 36 heroin users entering treatment were asked to compare their strongest cigarette urge to their strongest heroin urge. Most said the heroin urge was stronger, but two said the cigarette urge was, and II rated the two urges about the same.

In a sense, nicotine's compatibility with a wide range of tasks makes it more addictive than alcohol or heroin. But this is not the sort of thing people usually have in mind when they worry about addiction. Indeed, if it weren't for the health effects of smoking (and the complaints of bystanders exposed to the smoke), nicotine addiction Noun 1. nicotine addiction - an addiction to nicotine
drug addiction, white plague - an addiction to a drug (especially a narcotic drug)
 probably would be seen as no big deal, just as caffeine addiction is. As alternative sources of nicotine that do not involve smoking (gum, patches, inhalers, beverages, lozenges, oral snuff snuff, preparation of pulverized tobacco used by sniffing it into the nostrils, chewing it, or placing it between the gums and the cheek. The blended tobacco from which it is made is often aged for two or three years, fermented at least twice, ground, and usually ) become popular not just as aids in quitting but as long-term replacements, it will be interesting to see whether they will be socially accepted. Once the health risks are dramatically reduced or eliminated, will daily consumption of nicotine still be viewed as shameful and declasse dé·clas·sé  
adj.
1. Lowered in class, rank, or social position.

2. Lacking high station or birth; of inferior social status.
, as a disease to be treated or a problem to be overcome? Perhaps so, if addiction per se is the issue. But not if it's the medical, social, and psychological consequences of addiction that really matter.

The Needle and the Damage Done

To a large extent, regular heroin use also can be separated from the terrible consequences that have come to be associated with it. Because of prohibition, users face the risk of arrest and imprisonment Imprisonment
See also Isolation.

Alcatraz Island

former federal maximum security penitentiary, near San Francisco; “escapeproof.” [Am. Hist.: Flexner, 218]

Altmark, the

German prison ship in World War II. [Br. Hist.
, the handicap of a criminal record, and the violence associated with the black market. The artificially high price of heroin, perhaps 40 or 50 times what it would otherwise cost, may lead to heavy debts, housing problems, poor nutrition, and theft. The inflated cost also encourages users to inject the drug, a more efficient but riskier mode of administration. The legal treatment of injection equipment, including restrictions on distribution and penalties for possession, encourages needle sharing Needle sharing is the colloquialism for the reuse of syringes by multiple illegal drug users to administer intravenous drugs, and is a primary vector for diseases which can be transmitted through blood, including hepatitis and AIDS. , which spreads diseases such as AIDS and hepatitis. The unreliable quality and unpredictable purity associated with the black market can lead to poisoning and accidental overdoses.

Without prohibition, then, a daily heroin habit would be far less burdensome and hazardous. Heroin itself is much less likely to kill a user than the reckless combination of heroin with other depressants, such as alcohol or barbiturates Barbiturates Definition

Barbiturates are medicines that act on the central nervous system and cause drowsiness and can control seizures.
Purpose
. The federal government's Drug Abuse Warning Network The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors Drug-related visits to hospital emergency departments and Drug-related deaths investigated by medical examiners and coroners [https://dawninfo.samhsa.gov/default.asp].  counted 4,820 mentions of heroin or morphine morphine, principal derivative of opium, which is the juice in the unripe seed pods of the opium poppy, Papaver somniferum. It was first isolated from opium in 1803 by the German pharmacist F. W. A.  (which are indistinguishable in the blood) by medical examiners A public official charged with investigating all sudden, suspicious, unexplained, or unnatural deaths within the area of his or her appointed jurisdiction. A medical examiner differs from a Coroner in that a medical examiner is a physician.  in 1999. Only 438 of these deaths (9 percent) were listed as directly caused by an overdose of the opiate. Three-quarters of the deaths were caused by heroin/morphine in combination with other drugs. Provided the user avoids such mixtures, has access to a supply of reliable purity, and follows sanitary injection procedures, the health risks of long-term opiate consumption are minimal.

The comparison between heroin and nicotine is also instructive when it comes to the role of drug treatment. Although many smokers have a hard time quitting, those who succeed generally do so on their own. Surprisingly, the same maybe true of heroin addicts. In the early 1960S, based on records kept by the Federal Bureau of Narcotics The Federal Bureau of Narcotics (or FBN) was an agency of the United States Department of the Treasury. In June, 1930, Harry J. Anslinger was appointed its first commissioner by Secretary of the Treasury Andrew Mellon under President Herbert Hoover. , sociologist Charles Winick concluded that narcotic addicts tend to "mature out" of the habit in their 30S. He suggested that "addiction may be a self limiting process for perhaps two-thirds of addicts." Subsequent researchers have questioned Winick's assumptions, and other studies have come up with lower estimates. But it's clear that "natural recovery" is much more common than the public has been led to believe.

In a 1974 study of Vietnam veterans This article is about the French band. For veterans of the Vietnam War, see Vietnam veteran.
The Vietnam Veterans were a six-person French psychedelic group that released six records in the 1980s. The band was praised by many alternative music publications.
, only 12 percent of those who were addicted to heroin in Vietnam took up the habit again during the three years after their return to the United States. (This was not because they couldn't find heroin; half of them used it at least once after their return, generally without becoming addicted again.) Those who had undergone treatment (half of the group) were just as likely to be re-addicted as those who had not. Since those with stronger addictions were more likely to receive treatment, this does not necessarily mean that treatment was useless, but it clearly was not a prerequisite for giving up heroin.

Despite its reputation, then, heroin is neither irresistible nor inescapable. Only a very small share of the population ever uses it, and a large majority of those who do never become addicted. Even within the minority who develop a daily habit, most manage to stop using heroin, often without professional intervention. Yet heroin is still perceived as the paradigmatic See paradigm.  voodoo drug, ineluctably turning its users into zombies Zombies

Companies that continue to operate even though they are insolvent. Also known as living dead.

Notes:
It's advisable to avoid investing in zombies at all costs their life expectancies are highly unpredictable.
 who must obey its commands.

Heroin in Moderation

The idea that drugs cause addiction was rejected in the case of alcohol because it was so clearly at odds with everyday experience, which showed that the typical drinker was not an alcoholic. But what the psychologist Bruce Alexander This article is about the English actor. For the American mystery writer, see Bruce Cook.

Bruce Alexander is an English actor, perhaps most famous for his portrayal of Superintendent Mullet in the ITV television series A Touch of Frost
 calls "the myth of drug-induced addiction" is still widely accepted in the case of heroin--and, by extension, the drugs compared to it (see sidebar)--because moderate opiate users are hard to find. That does not mean they don't exist; indeed, judging from the government's survey results, they are a lot more common than addicts. It's just that people who use opiates in a controlled way are inconspicuous in·con·spic·u·ous  
adj.
Not readily noticeable.



incon·spic
 by definition, and keen to remain so.

In the early 1960s, however, researchers began to tentatively identify users of heroin and other opiates who were not addicts. "Surprisingly enough," a Northwestern University Northwestern University, mainly at Evanston, Ill.; coeducational; chartered 1851, opened 1855 by Methodists. In 1873 it absorbed Evanston College for Ladies.  psychiatrist wrote in 1961, "in some cases at least, narcotic use may be confined to weekends or parties and the users may be able to continue in gainful gain·ful  
adj.
Providing a gain; profitable: gainful employment.



gainful·ly adv.
 employment for some time. Although this pattern often deteriorates and the rate of use increases, several cases have been observed in which relatively gainful and steady employment has been maintained for two to three years while the user was on what might be called a regulated or controlled habit."

A few years later, Harvard psychiatrist Norman Zinberg and David C. Lewis For other persons named David Lewis, see David Lewis (disambiguation).

David C. Lewis is a keyboardist and composer.

He played with Ambrosia from 1977 – 1983; and with Shadowfax from 1984 - 1990, with whom he won the Grammy for "Best New Age Performance" for
, then a medical resident, described five categories of narcotic users, including "people who use narcotics narcotics n. 1) techinically, drugs which dull the senses. 2) a popular generic term for drugs which cannot be legally possessed, sold, or transported except for medicinal uses for which a physician or dentist's prescription is required.  regularly but who develop little or no tolerance for them and do not suffer withdrawal symptoms." They explained that "such people are usually able to work regularly and productively. They value the relaxation and the 'kick' obtained from the drug, but their fear of needing more and more of the drug to get the same kick causes them to impose rigorous controls on themselves."

The example offered by Zinberg and Lewis was a 47-year-old physician with a successful practice who had been injecting morphine four times a day, except weekends, for 12 years. He experienced modest discomfort on Saturdays and Sundays, when he abstained, but he stuck to his schedule and did not raise his dose except on occasions when he was especially busy or tense. Zinberg and Lewis' account suggests that morphine's main function for him was stress relief: "Somewhat facetiously, when describing his intolerance of people making emotional demands on him, he said that he took 1 shot for his patients, 1 for his mistress, 1 for his family and 1 to sleep. He expressed no guilt about his drug taking, and made it clear that he had no intention of stopping."

Zinberg eventually interviewed 61 controlled opiate users. His criteria excluded both dabblers (the largest group of people who have used heroin) and daily users. One subject was a 41-year-old carpenter who had used heroin on weekends for a decade. Married 16 years, he lived with his wife and three children in a middle-class suburb. Another was a 27-year-old college student studying special education. He had used heroin two or three times a month for three years, then once a week for a year. The controlled users said they liked "the 'rush' (glow or warmth), the sense of distance from their problems, and the tranquilizing powers of the drug." Opiate use was generally seen as a social activity, and it was often combined with other forms of recreation. Summing up the lessons he learned from his research, Zinberg emphasized the importance of self-imposed rules dictating when, where, and with whom the drug would be used. More broadly, he concluded that "set and setting"--expectations and environment--play crucial roles in shaping a drug user's experience.

Other researchers have reported similar findings. After interviewing 12 occasional heroin users in the early 1970s, a Harvard researcher concluded that "it seems possible for young people from a number of different backgrounds, family patterns, and educational abilities to use heroin occasionally without becoming addicted." The subjects typically took heroin with one or more friends, and the most frequently reported benefit was relaxation. One subject, a 23-year-old graduate student, said it was "like taking a vacation from yourself...When things get to you, it's a way of getting away without getting away." These occasional users were unanimous in rejecting addiction as inconsistent with their self-images. A 1983 British study of 51 opiate users likewise found that distaste for the junkie junkie Popular health A popular term for a person, usually an IV narcotic abusing addict, whose life is disorganized vis-á-vis family and societal structure, whose existence revolves around obtaining–often through theft, prostitution or other illicit  lifestyle was an important deterrent to excessive use.

While these studies show that controlled opiate use is possible, the 1974 Vietnam veterans study gives us some idea of how common it is. "Only one-quarter of those who used heroin in the last two years used it daily at all," the researchers reported. Likewise, only a quarter said they had felt dependent, and only a quarter said heroin use had interfered with their lives. Regular heroin use (more than once a week for more than a month) was associated with a significant increase in "social adjustment problems," but occasional use was not.

Many of these occasional users had been addicted in Vietnam, so they knew what it was like. Paradoxically, a drug's attractiveness, whether experienced directly or observed secondhand, can reinforce the user's determination to remain in control. (Presumably pre·sum·a·ble  
adj.
That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster.
, that is the theory behind all the propaganda warning how wonderful certain drug experiences are, except that the aim of those messages is to stop people from experimenting at all.) Aneuroscientist in his late 205 who smoked heroin a couple of times told me it was "nothing dramatic, just the feeling that everything was OK for about six hours, and I wasn't really motivated to do anything." Having observed several friends who were addicted to heroin at one time or another, he understood that the experience could be seductive, but "that kind of seduction Seduction
See also Flirtatiousness.

Selfishness (See CONCEIT, STINGINESS.)

Armida

modern Circe; sorceress who seduces Rinaldo. [Ital. Lit.: Jerusalem Delivered]

Aurelius Dorigen’s

nobleminded would-be seducer.
...kind of repulsed me. That was exactly the kind of thing that I was trying to avoid in my life."

Similarly, a horticulturist in his 405 who first snorted heroin in the mid-1980s said, "It was too nice." As he described it, "you're sort of not awake and you're not asleep, and you feel sort of like a baby in the cradle, with no worries, just floating in a comfortable cocoon cocoon: see pupa. . That's an interesting place to be if you don't have anything else to do. That's Sunday-afternoon-on-the-couch material." He did have other things to do, and after that first experience he used heroin only "once in a blue moon very rarely; - from the observation that the moon rarely has a bluish tint.

See also: blue moon
." But he managed to incorporate the regular use of another opiate, morphine pills, into a busy, productive life. For years he had been taking them once a week, as a way of unwinding and relieving the aches and pains from the hard manual labor required by his landscaping business. "We use it as a reward system;' he said. "On a Friday, if we've been working really hard and we're sore and it's available, it's a reward. It's like, 'We've worked hard today. We've earned our money, we paid our bills, but we're sore, so let's do this. It's medicine."'

Better Homes & Gardens

Evelyn Schwartz learned to use heroin in a similar way: as a complement to rest and relaxation rather than a means of suppressing unpleasant emotions. A social worker in her 50s, she injected heroin every day for years but was using it intermittently when I interviewed her a few years ago. Schwartz (a pseudonym pseudonym (s`dənĭm) [Gr.,=false name], name assumed, particularly by writers, to conceal identity. A writer's pseudonym is also referred to as a nom de plume (pen name). ) originally became addicted after leaving home at 14 because of conflict with her mother. "As I felt more and more alienated al·ien·ate  
tr.v. al·ien·at·ed, al·ien·at·ing, al·ien·ates
1. To cause to become unfriendly or hostile; estrange: alienate a friend; alienate potential supporters by taking extreme positions.
 from my family, more and more alone, more and more depressed," she said, "I started to use [heroin] not in a recreational fashion but as a coping mechanism coping mechanism Psychiatry Any conscious or unconscious mechanism of adjusting to environmental stress without altering personal goals or purposes , to get rid of feelings, to feel oK....I was very unhappy...and just hopeless about life, and I was just trying to survive day by day for many years."

But after Schwartz found work that she loved and started feeling good about her life, she was able to use heroin in a different way. "I try not to use as a coping mechanism," she said. "I try very hard not to use when I'm miserable, because that's what gets me into trouble. It's set and setting. It's not the drug, because I can use this drug in a very controlled way, and I can also go out of control." To stay in control, "I try to use when I'm feeling good," such as on vacation with friends, listening to music, or before a walk on a beautiful spring day. "If I need to clean the house, I do a little heroin, and I can clean the house, and it just makes me feel so good."

Many people are shocked by the idea of using heroin so casually, which helps explain the controversy surrounding a 2001 BBC BBC
 in full British Broadcasting Corp.

Publicly financed broadcasting system in Britain. A private company at its founding in 1922, it was replaced by a public corporation under royal charter in 1927.
 documentary that explored why people use drugs. "Heroin is my drug of choice over alcohol or cocaine," said one user interviewed for the program. "I take it at weekends in small doses, and do the gardening." It may be unconventional, but using heroin to enliven en·liv·en  
tr.v. en·liv·ened, en·liv·en·ing, en·liv·ens
To make lively or spirited; animate.



en·liven·er n.
 housework or gardening is surely wiser than using it to alleviate grief, dissatisfaction, or loneliness. It's when drugs are used for emotional management that a destructive habit is apt to develop.

Even daily opiate use is not necessarily inconsistent with a productive life. One famous example is the pioneering surgeon William Halsted, who led a brilliant career while secretly addicted to morphine. On a more modest level, Schwartz said that even during her years as a self-described junkie she always held a job, always paid the rent, and was able to conceal her drug use from people who would have been alarmed by it. "I was always one of the best secretaries at work, and no one ever knew, because I learned how to titrate ti·trate
v.
To determine the concentration of a solution by titration or perform the operation of titration.



ti
 my doses," she said. She would generally take three or four doses a day: when she got up in the morning, at lunchtime, when she came home from work, and perhaps before going to sleep. The doses she took during the day were small enough so that she could get her work done. "Aside from the fact that I was a junkie," she said, "I was raised to be a really good girl and do what I'm supposed to do, and I did."

Schwartz, a warm, smart, hard-working woman, is quite different from the heroin users portrayed by government propaganda. Even when she was taking heroin every day, her worst crime was shoplifting Ask a Lawyer

Question
Country: United States of America
State: Florida

caught shoplifting at sears 12/05/05, first time, 20yearsold, have no criminal record.
 a raincoat for a job interview. "I never robbed," she said. "I never did anything like that. I never hurt a human being. I could never do that....I'm not going to hit anybody over the head....I went sick a lot as a consequence. When other junkies would commit crimes, get money, and tighten up Verb 1. tighten up - restrict; "Tighten the rules"; "stiffen the regulations"
constrain, stiffen, tighten

confine, limit, throttle, trammel, restrain, restrict, bound - place limits on (extent or access); "restrict the use of this parking lot"; "limit the
, I would be sick. Everyone used to say: 'You're terrible at being a junkie."'

RELATED ARTICLE: Smackdown!

Which drug is most addictive?

Jacob Sullum Jacob Z. Sullum (born September 5, 1965) is a syndicated newspaper columnist and a Senior Editor at Reason magazine. In 2004, he received a Thomas S. Szasz Award. [1]

Sullum is the author of:
 

No substance can be taken seriously as an addictive drug until it is compared to heroin. That is why Newsweek, when it sought to stir up alarm about crack cocaine in 1986, called it "intensely addictive, a drug whose potential for social disruption δSocial disruption is a term used in sociology to describe the alteration or breakdown of social life, often in a community setting. For example, the closing of a community grocery store might cause social disruption in a community by removing a “meeting ground”  and individual tragedy is comparable only to heroin." Three paragraphs later, the magazine cited a Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850.  detective who "readily compares [crack] to heroin."

Having established crack as heroin's equal, Newsweek immediately announced that in fact it was worse. "While atypical heroin addict shoots up once or twice a day," the article said, "crack addicts need another hit within minutes." In the same issue, the magazine's editor-in-chief declared crack "the newest, purest and most addictive commodity now on the market." Newsweek also quoted the psychopharmacologist Arnold Washton, who claimed, "Crack is the most addictive drug known to man," causing "almost instantaneous addiction."

Although cocaine, whether snorted or smoked, was never as powerful as its press implied, that did not stop it from becoming a new touchstone of addictiveness. So when President Clinton wanted to scare the public about methamphetamine, he warned that the drug could become "the crack of the '90s." Less than two years later, with just a couple years to go in the decade, drug czar The term Drug Czar is an informal title that can mean: United States
Between 1973 and 1988, several ad hoc executive positions were established that the press termed "Drug Czar".
 Barry McCaffrey Barry Richard McCaffrey (b. November 17 1942, Taunton, Massachusetts) is a retired United States Army General. He currently serves as an Adjunct Professor at the United States Military Academy, where he had been the Bradley Professor of International Security Studies from 2001 to  was reassuring the public that methamphetamine would not become "the crack cocaine of the '90s," thanks to "drug education programs."

But for a while there, methamphetamine was "the most malignant, addictive drug known to mankind," as a physician told The New York Times. A federal prosecutor declared it "more addictive than crack." The head of the Drug Enforcement Administration The Drug Enforcement Administration (DEA) was established in 1973 by President richard m. nixon as part of the Justice Department, thus uniting a number of federal drug agencies that had often worked at cross-purposes. , officially charged with discouraging drug use, said the meth meth
n.
Methamphetamine hydrochloride.
 high "is about 10 times more pleasurable than any other sensual experience."

U.S. News & World Report U.S. News & World Report

Weekly newsmagazine published in Washington, D.C. U.S. News was founded in 1933 by David Lawrence (1888–1973) to cover important domestic events; he founded World Report in 1945 to treat world news. The two magazines were merged in 1948.
 began a story by describing a Phoenix beautician for whom "the seductive allure of methamphetamine took hold almost immediately." As she put it, "The first line I ever did, I thought, 'My God, this is it. This is the answer to all the world's problems.'...It's the ultimate high. You're like Wonder Woman. It makes you feel so powerful. You have tons of energy. You feel like you can do anything. I loved it. I craved it. It was total euphoria." As if to make up for this breathless advertising, U.S. News quickly added that "methamphetamine turned her euphoria into a free-fall nightmare"--"as it almost always does."

This image of an instantly, inevitably addicting drug was familiar to anyone who had followed the news media's crack coverage. But while crack was said to be especially addictive because the high was so brief, meth was said to be even more dangerous because the high lasted so long.

Methamphetamine's power was validated by reference to crack, while crack's power was validated by reference to heroin. Crack was said to be just as addictive as heroin, if not more so. Meth was like crack, only worse. And throughout this period, public health officials and anti-smoking activists were emphasizing that nicotine was "more addictive than heroin." So even as heroin served as a model for addictiveness, its reputed power was implicitly downgraded.

More recently, however, heroin has been making a comeback in the press. In 2001, under the headline "Deadly Lure," the New Orleans New Orleans (ôr`lēənz –lənz, ôrlēnz`), city (2006 pop. 187,525), coextensive with Orleans parish, SE La., between the Mississippi River and Lake Pontchartrain, 107 mi (172 km) by water from the river mouth; founded  Times Picayune Picayune (pĭkəyn`), city (1990 pop. 10,633), Pearl River co., S Miss., near the Pearl River and the La. line; inc. 1904.  warned that heroin is "more addictive than crack cocaine."

Jacob Sullum (jsullum@reason.com) is a senior editor at reason. Reprinted from Saying Yes: In Defense of Drug Use, with permission of Jeremy P. Tarcher, a member of Penguin Group (USA), Inc. [C]2003 by Jacob Sullum.
COPYRIGHT 2003 Reason Foundation
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2003, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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